The objective of this grant is to bring together a collaborative research team including anthropologists, public health specialists, health care personnel from various Samoan communities, and others as necessary to forge a program to investigate factors contributing to the risk and complications of diabetes among modernizing Samoans. Samoan Americans are Polynesians, Pacific Islanders, comprising approximately 100,000 individuals, members of the fastest growing segment of the US population, Asians/Pacific Islanders. The primary population concentrations of Samoan Americans are found in the Territory of American Samoa, on the island of Oahu, Hawaii, and in several urban areas in California. While it is known that diabetes poses a severe and constant health threat to modernizing Samoans and other Pacific Islanders, the true extent of the problem is not yet known, nor is much known about the diabetes risks associated with specific aspects of the modernizing lifestyle. Our approach is three-fold: 1) we will draw on already existing data sets for further analysis; 2) we will conduct a chart review at the LBJ Tropical Medical Center, American Samoa, and other clinic sources in Hawaii and California to estimate the prevalence of diabetes and diabetic complications and to describe the distribution of diabetes across the three communities of Samoan Americans; and 3) we will work with the collaborators from different Samoan communities to devise a follow-up research proposal that is responsive to the interests of these groups and which will yield culturally responsive approaches to prevention and control of diabetes. The analysis of existing data will include work on the 1988 Diabetes Registry for American Samoa which was collected by the CI and PI in 1989, as well as continuing analysis of other information collected as part of the on-going Samoan Studies Project. The chart review will include information on thousands of patients, and provide preliminary diabetes and complication prevalence estimates, although these may be biased particularly by lack of representation from the Hawaii and California communities. Strengths of the proposed research include the long experience of the PI and CI in health-related research among Samoans; the collaboration of health care workers in the Samoan communities; the apparently high prevalence of diabetes and complications among Samoans; the expertise of the research team in the analysis of diabetes mortality, the measurement of obesity, diet, and activity, and the measurement of lifestyle among Samoans; and the existence of a collaborative relationship with the Health Planning Office of American Samoa for continued research on Samoan health.